Paul Gilligan: Deep stigma surrounding mental health costs lives

People are reluctant to discuss their emotional problems and
feel that they cannot seek help, writes Paul Gilligan

Twenty per cent of people believe that those suffering from mental health
problems are of below average intelligence. Over 40 per cent consider seeking
help for a mental health problem to be a sign of personal failure.

Two-thirds expressed reluctance to hire a person with a history of mental
illness believing them to be unreliable, and over 30 per cent indicated they
would not willingly accept someone with a mental health problem as a close
friend.

Those are the findings of a poll of 300 people -- admittedly a relatively
small sample -- carried out St Patrick's University Hospital in Dublin.

Many, particularly those who suffer from mental health problems, expressed
empathy having experienced these types of negative views in their own lives.
Others expressed surprise, believing that most people see those who suffer from
mental health problems as being gifted and highly intelligent. Many pointed to
the number of celebrities and public figures admitting to suffering from such
problems and some suggested that declaring you have a mental health problem has
become "trendy".

The reality is that stigma regarding mental health is often subtle, is
extremely damaging and is deeply ingrained in Irish society. In fact, the
research findings probably underestimate the level of stigma given that many who
respond to such surveys do not want to admit to holding negative views.

It is not surprising that such stigma exists given the very human factors of
fear and lack of knowledge. Most of us at some stage in our lives have directly
experienced mental health problems during which we have felt particularly
distressed, hopeless or out of control. For many of us, coping with these
feelings requires us to deny their existence, to bury them in our subconscious
and to avoid confronting our emotional and psychological selves.

To protect ourselves, we reject the notion of mental health problems and we
reject those who declare that they experience such problems. Related to this is
a lack of understanding and knowledge about the true nature of mental health and
the problems that can arise.

The media also plays a part. Surveys conducted in the UK in 1998 by the Royal
College of Psychiatrists found that people experiencing mental health problems
consider media coverage of such problems to be strongly biased toward the
sensational and the negative. The main complaint from mental health
professionals, as well as sufferers, is that the media present mentally ill
people as "dangerous time bombs waiting to explode" when in fact the vast
majority of serious crime is committed by people with no mental illness.

Clinicians, policy makers and health managers' attitudes toward those with
mental health difficulties are increasingly being recognised also as part of the
problem of stigmatisation, because of their tendency to see mental health
problems as social issues rather than as a health issue and their lack of
understanding and specialised training and their mistaken belief that no
effective treatments exist. The stigma often extends to family members, because
they are seen as the source of the problem.
In Ireland over the last five years, much of the discussion around mental
health has centred on the negative aspects of in-patient care and this has
undoubtedly added to the stigma of what is often an essential aspect of mental
health treatment.

Stigma is complex. Some forms of mental health problems, such as depression
and anxiety, have become more accepted because people are more likely to
attribute these difficulties to stress, with which most can identify. On the
other hand, the stigma associated with psychosis appears to have worsened. Today
the types of mental health problems that carry the heaviest stigma are those
associated in the popular mind with violence and/or illegal activity,
embarrassing social behaviour or visible side effects of medication.

As a result, people are extremely reluctant to discuss their mental health
problems and they feel they are letting themselves and their family down if they
seek help. Those seeking help from St Patrick's have usually suffered for years
before making the decision to come to terms with their distress. Many in
desperation and despair do not seek help but take their own lives. Stigma costs
lives.

We need to run consistent and extensive national education and
awareness-raising campaigns, we need to ensure mental health awareness becomes a
core part of the school curriculum and we need to tackle negative beliefs among
clinicians, policy makers and health managers. We must encourage people to talk
about their distress and seek help when they require it and we need to build
people's confidence in the mental health services, guaranteeing them that they
will receive the highest quality, most effective services which will treat them
with dignity and respect and will empower them to take back control of their own
lives on their journey towards recovery.

Most importantly, we need to acknowledge our own experiences and fears about
mental health, confront our biases and educate ourselves on the true nature of
mental health and well-being.